A Question of Famine: IPC Food Security Phases and the Gaza Debate

E. Mark Windle 25 March 2025.

(Audio version is also available here for Medium members)

Humanitarian crises management requires input from a range of invested but not necessarily directly connected agencies. One element of coordinating interventions involves common understanding of the current state of food insecurity. The Integrated Food Security Phase Classification (IPC) scale addresses this by capturing nutritional data, highlighting levels of severity. IPC designations have been used in Gaza since before the current conflict, and have played an essential role in facilitating action plans to improve nutritional welfare. Inevitably, they have also been a source of sparring between aid agencies and pro-Israel lobbyists.

ORIGINS

IPC designations were a concept of a division of the UN Food and Agriculture Organisation (FAO) working in Somalia. The country has a long history of nutritional fragility due to poverty, politics and drought. FAO’s Security and Nutrition Analysis Unit had a desperate need for a system that could capture robust data from different sources, and so enable effective utilisation of humanitarian aid.

The IPC was first rolled out in February 2004. It proved an invaluable tool later that year, when the Indian Ocean Earthquake created a tsunami, devastating coastal and rural areas of the Puntland state to the north, and displaced 50,000 people from their homes. Timely, coordinated input was required to manage the immediate and longer-term situation.

Since then, the IPC has been refined a number of times and is now the tool of choice in standardising the monitoring and description changes in food security in over 30 countries. The IPC global partnership comprises 20 intergovernmental institutions and organisations, including WHO, Save the Children, the Famine Early Warning Systems Network (FEWS NET), Action Against Hunger, and UN agencies such as UNICEF, FAO and the World Food Programme.

MALNUTRITION AND FOOD SECURITY PHASES IN BRIEF

The classification system comprises three scales which reflect reflect separate themes — global acute malnutrition (GAM), acute food insecurity (AFI), and chronic food insecurity (CFI). The severity of each is determined via the collection of raw data sets sourced from a range of settings.

Prevalence of malnutrition (GAM): from body weight and other indirect physiological measures of nutritional status. This information is verified, pooled, and categorised according to five phases of malnutrition severity. Phase 1 represents a low prevalence of GAM (less than 5–6% of children). Guidance in phase 1 emphasises continued monitoring and existing actions. Phase 5 is the upper extreme, representing a GAM prevalence of greater than 17% or 30% dependent on the basis of measurement.

Acute Food Insecurity (AFI): questionnaires are used to capture household ease of coping with sudden changes in food security. This information is converted to quantifiable data and combined with acute malnutrition values. Results are pooled and categorised according to five phases of AFI severity. Households with full and free access to essential and non-essential foods score lowest (phase 1). Phase 3 indicates an acute food security crisis, with a recommendation for urgent action to correct reduced food consumption. The priority for phase 4 (emergency) is to save lives. Phase 5 is the most severe category described as ‘catastrophic’ on a household or small group level, or ‘famine’ on an area level. Phase 5 indicates an urgent need for action to prevent or minimise widespread deaths related to malnutrition.

Chronic Food Insecurity (CFI): tools used here are similar to that for AFI phase determination. There are four levels of CFI severity. Levels 3 and 4 (moderate and severe CFI) require urgent action to address issues of ongoing deficits in food quantity which are sustained, or seasonal, and likely to provide inadequate nutrition in the household.

FAMINE DESIGNATION THRESHOLDS

From a humanitarian aid perspective, a formal definition of famine risk and famine occurrence is essential. Heralding it is not only a trigger for coordination of international action; in conflict-related situations the acknowledging the existence of famine can be used to inform legal proceedings for war crimes under international law. The ultimate purpose though of the IPC system is to identify impending situations of famine, so that governement agencies and NGOs are alerted to the need for intervention in a timely manner, with the intention of averting or minimising mass malnutrition and death.

Thresholds for an IPC-designated famine are found in phase 5 of the AFI scale:

1. At least 20% of households have an extreme lack of food and other basic needs according to food security inquiry

2. Acute malnutrition prevalence exceeds 30% based on weight-for-height “z-scores” (or lesser percentage threshold where Mid Upper Arm Circumference is used for assessment)

3. A mortality rate exceeding 2 deaths per day per 10,000 people, where those deaths are due directly to starvation or to the interaction of malnutrition and disease.

IPC guidelines also refer to the phrase “risk of famine”, but are clear that this descriptor sits outside the core classification system. It should be arrived at by consensus on a projected worst-case scenario with a reasonable and realistic chance of famine occurring. The designation of risk of famine allows for consideration of lesser quality (and quantity) of evidence. Food security and nutritional status monitoring should be routine and continuous. The IPC Famine Review Committee (FRC) regularly convene to consider 3–6 monthly projections for the likelihood of famine developing.

‘RISK OF FAMINE’ DESIGNATIONS IN GAZA , POST 7 OCTOBER 2023

So how does this all fit into the current conflict in Gaza? The FRC first indicated that a risk of famine existed two months after the start of the Israel-Hamas conflict. In March 2024, projected analysis concluded famine would be expected at some point between mid-March and May in northern Gaza and wider Gazan governates. Monitoring the situation, FEWS NET conducted an IPC-compatible analysis of food security in the same timeframe. It was concluded famine was indeed established and had been ongoing in northern Gaza during April.

The FRC followed this up with a review of the FEWS NET findings. While the FRC felt the FEWS NET evidence was not necessarily contradictory, it was not robust enough to categorise famine with certainty. The FRC had noted that the amount of food and non-food commodities entering Gaza had actually increased, and WASH systems had also been scaled up in line with IPC guidance. Based on the FRC review, the opinion was that it was more plausible that all areas in Gaza were in a lesser emergency situation (IPC phase 4) during May and June; and that this would likely remain the position until the next FRC analysis in October. It was, however, emphasised that famine would continue to pose a genuine threat for as long as conflict continued or humanitarian access was restricted.

Despite the FRC conclusions made a month earlier, in July 2024 the UN issued a press release stating that a group of independent experts—UN advisors—concluded that famine had spread throughout the entire Gaza Strip. The rationale was that at least 40 children had died directly as a result of malnutrition since the start of the war. That information in itself was not fit for IPC-designation of famine.

In October and November, one year into the conflict, the UN were now classing the whole territory of Gaza as in an IPC phase 4 (emergency) situation. UN estimates were that 1.8 million Palestinians were experiencing extremely critical levels of hunger, with limited access to food and 70% of crop fields destroyed. UN Secretary-General Antonio Guterres commented on social media:

“Alarmed by today’s IPC report findings that high displacement and restrictions on humanitarian aid flows mean people in Gaza are facing catastrophic levels of hunger… widespread famine looms. This is intolerable.”

Between 2011 and 2024, the FRC categorised four episodes of famine in the world; one in Somalia and three in Sudan. Since the start of the Israel-Hamas conflict, various agencies have expressed concerns of famine developing in Gaza. Warnings have usually been accompanied by a statement that famine will occur if there is no immediate ceasefire to allow aid passage. As yet however, IPC famine has not been designated by the FRC.

ISRAEL DENIES FOOD SHORTAGE

Contradictory official reports and ad hoc comments from representatives of humanitarian aid organisations, plus media quests for headline-selling soundbites have all had the potential to create ambiguity and public confusion. Israeli officials and pro-Israeli lobbyists frequently voice that the pushing of a narrative of impending famine is inaccurate, discredits Israel, and fosters anti-Israeli sentiment.

In the spring of 2024, Colonel Moshe Tetro of the Coordination of Government Activities in the Territories (COGAT) agency went on record denying that there was any shortage of food in Gaza. His comment likely came from a report, unpublished or peer reviewed at the time, that between January and April of that year there had been an average of 3,163kcal per person per day of aid delivered. Well in excess of individual baseline requirements. The figure was informed by COGAT data on the number of aid trucks entering Gaza, consignment weights of specific foods, and the nutritional composition of standard food parcels.

However, the apparent abundance of food was in stark contrast with that observed on the ground in most, if not all parts of Gaza. The COGAT view was essentially that if food wasn’t reaching civilians once it was inside the Gaza Strip, that was not a matter for Israel — internal distribution chains were not their responsibility.

Crowd looting, the interception of food drop-offs by organised gangs, the hoarding of food by Hamas, and the threat of executions of those who liaise with Israel in the distribution of aid have indeed been reported. But equally, access to food delivered by truck has been hampered on multiple occasions by Israeli forces inside Gaza, by roadblocks, forced offloading of aid in military zones where civilians have no access, and drop-offs at schools and other public buildings which are immediately targeted by Israeli soldiers and civilians forced to leave empty handed.

ALLEGATIONS OF DATA MISHANDLING

In Review of Famine Reports earlier this year, UK Lawyers for Israel (UKLFI) claimed a number of fundamental flaws appear in work by the IPC/FRC, FAO and FEWS NET. Criticisms include the use of inaccurate statistics, misinterpretation of raw data and poor data processing to arrive at a risk of famine designation. According to UKLFI, food and water supply data was overlooked, erroneous baseline data used to support a projection of rapidly developing malnutrition, mortality statistics were based on partly unverified data and were poorly handled, and an overestimation of population size reduced the amount of food available per person.

The group also stressed that famine narratives from Guterres and other high level UN representatives were building an atmosphere of urgency, when according to IPC’s own guidance, “risk of famine” terminology refers specifically to a worst-case scenario, rather than the most likely outcome. Of course, UKLFI’s pro-Israel agenda is obvious, with a past history of lodging complaints (with limited success) against protests and charities that support the Gaza causes. But with a formal response to the report still awaited, the validity of their comments remain unchallenged.

DIFFICULTIES OF DATA COLLECTION AND INTERPRETATION

IPC threshold values are generally accepted as logical and the face-value descriptors for each phase designation clear. One limitation is system clunkiness, characterised by caveats, exclusions, and scenario deviations requiring specific considerations when collecting data. Unfortunately this leaves users of a system which is designed to be constructive tool open to criticism. It also leaves famine-related designations subject to debate, especially by pro-Israeli entities who work to block anything that could further cement any references to the possibility of genocide.

IPC phase designations are best informed by strong evidence. The threshold for famine requires the availability of solid statistical information on food insecurity, malnutrition and deaths. The most robust evidence comes from first hand sources, is complete, and can be relied upon to be accurate.

The reality, however, is that high quality evidence is often difficult to obtain in conflict zones. In an IPC context, weights and anthropometric measurements for malnutrition statistics can only be taken where health services are operational. Where these services are located in centralised hubs rather than in camps, individuals can only access these services if it is safe to do so, and then often only if the facility is near enough to access on foot. Sample sizes may be small, and findings require additional assumptions for scaling up and inference.

Death rates are equally tricky to interpret. Rates used in inform famine classification should only reflect those only those caused directly by starvation, or the interaction of malnutrition and disease, rather than total death rate. Where the total mortality is known, deaths from trauma (such as combat or sudden civilian deaths in targeted residential areas) should be excluded — or assumptions made where trauma deaths are unobtainable. Determination of the number of deaths related to malnutrition is particularly complex because of the interrelationships between malnutrition, disease and, where present, injury. Death from sepsis or from dehydration can occur in overwhelming infective disease, with or without the presence of malnutrition. So, at an individual level, documentation is required of both the primary cause of death and whether or not malnutrition is present.

Regardless of when or whether the FRC bell will ring to announce the arrival of famine in Gaza, only blinkered deniers will contest that the numbers dying from frank malnutrition, disease-related malnutrition, and injuries complicated by infection and poor nutritional status will be high. Potentially, much more than the 50,000 total deaths currently reported. The strive for best evidence—or failing that, best consensus—is crucial for humanitarian and legal calls to action. Undeniably, the collection and interpretation of food insecurity and malnutrition data in Gaza has been problematic. But we shouldn’t be throwing the baby out with the bath water.

(Copyright 2025) E. Mark Windle is a freelance writer, with a former 25-year career as a clinical dietitian specialising in major burn injury and critical care nutrition. He has also worked as a senior writer for Story Terrace (London, UK), and as a ghostwriter for Sheridan Hill / Real Life Stories LLC (North Carolina, USA).